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N e56W <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -a Q Z <br /> APPLICATION FOR LAND USE PERMITS _ 4 <br /> r <br /> - a » <br /> OWNER r� cS'�}� '!"' TELEPHONE 6,56— �a�r .a r� <br /> 60-436- 65-LKI "',K v1 <br /> HOMEADDRESS /77 61 �Clf—/� �j�j�� �,(� Jp''gA_'I U6't! <br /> I w m yyy <br /> EMERGENCY/FIRE NUMBER 775 ROAD NAME ` 1 <br /> r 1 <br /> LEGAL DESCRIPTION(see tax receipt) w <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION c ' <br /> SANITARYPRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION Q <br /> -Few ewe /nr a C X v_5/' modular iqr— r�,, <br /> STRUCTURE/ADDITION USE: /Z 1C 7O TXXXLL7'Z T l,34C �'�+7DcJ l�C�n'1 <br /> rr el nnnn .� •� <br /> X ,e/ <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) 0?7`' 4rJ� v <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 2 <br /> DIRECTIONS FOR PLOT PLAN DRAWING (AERIAL OR TOP VIEW) O <br /> m � <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m S <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO mz <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, <br /> STREAM OR RIVER. o <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO BUILD- <br /> INGS, ROADS,LAKE, LOT LINES. `2 <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS <br /> MUST BE SIGNED AND DATED BY THE OWNER. m o <br /> O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE <br /> ISSUED. <br /> V / � <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: p W <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ^ <br /> ISSUANCE. kU� <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN 75 FEET OF E OHWM OF LAKES, <br /> PONDS, RIVER UNLESS <br /> SPEC/!IF/ICALLY PERMITTED/.. <br /> e /2v" <br /> m m m m o g o m <br /> m <br /> o : <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my E GZ g E E E p <br /> knowledge and belief it Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m E f E C <br /> n <br /> all information contained in this application(Including any accompanying schedule)and I further declare that I recognize o 'e i i , m <br /> that this Information I am providing will be relied upon by the County of Bumett Wisconsin in determining whether to Is- <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this Information I am <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m E <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m <br /> m <br /> at <br /> w : <br /> SIGN HERE <br /> is n re of own r Ilding contractor) (date) <br /> ZONING AISTRATOR <br /> � HNMHH <br /> N N f m N N N <br /> ra N O rm V7 , O <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 <br />